Provider Demographics
NPI:1366652349
Name:JAMES J. SHEN, M.D., P.C.
Entity Type:Organization
Organization Name:JAMES J. SHEN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JUH
Authorized Official - Last Name:SHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-948-2121
Mailing Address - Street 1:453 COLON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-1419
Mailing Address - Country:US
Mailing Address - Phone:718-948-2121
Mailing Address - Fax:718-967-1281
Practice Address - Street 1:453 COLON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-1419
Practice Address - Country:US
Practice Address - Phone:718-948-2121
Practice Address - Fax:718-967-1281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116662208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB78315Medicare UPIN